5/18/12 Russia - Health

Russia Table of Contents

Russia has an entrenched, albeit underfunded, system of socialized medicine. Basic medical
care is available to most of the population free of cost, but its quality is extremely low by
Western standards, and in the mid-1990s the efficiency of the system continued the decline
that had begun before the collapse of the Soviet system. In the first four post-Soviet years,
that decline was typified by significant increases in infant and maternal mortality and
contagious diseases and by decreases in fertility and life expectancy.

Health Conditions
The decline in health is attributable in part to such environmental and social factors as air and
water pollution, contamination (largely from nuclear accidents or improper disposal of
radioactive materials), overcrowded living conditions, inadequate nutrition, alcoholism, and
smoking, and in part to a lack of modern medical equipment and technology. In 1991 life
expectancy in Russia was 74.3 years for females and 63.5 years for males. By 1994 the
figure for males was 57.3 years. The male-to-female ratio in the population reflects the higher
male mortality rate and the enduring impact of losing millions more males than females in
World War II. (In all age-groups below thirty-five, there are more males than females.) In
1993 the overall ratio was 884 males per 1,000 females, and experts predicted that the figure
for males would decline to around 875 by the year 2005 (see Demographic Conditions, ch.

By the mid-1990s, Russia's death rate had reached its highest peacetime level in the twentieth
century. Curable infectious diseases such as diphtheria and measles have reached epidemic
levels unseen since the Bolshevik Revolution, and the rates of tuberculosis, cancer, and heart
disease are the highest of any industrialized country.

In 1993 the incidence of a number of infectious diseases increased significantly over the
previous year: tuberculosis by 1.25 times, brucellosis by 1.9 times, diphtheria by 3.9 times,
and syphilis by 2.6 times (see table 14, Appendix). In 1995 the Russian health system was
overwhelmed by the return of epidemic diseases such as cholera and typhoid fever, even as it
faced chronic staff and equipment shortages. In the winter of 1995-96, Russia suffered its
most severe epidemic of influenza in decades. An estimated 1 million people were infected in
Moscow alone, and numerous schools and public institutions were closed to prevent the
spread of the disease. Experts attributed the virulence of the epidemic to the generally low
level of resistance of much of the Russian population, the result of poor overall health care
and stressful economic conditions. Other causes were the uneven availability of influenza
shots and the population's general belief that injections enhance rather than decrease an
individual's chances of becoming ill.

Between 1980 and 1989, cancer and its complications increased from 15 percent to 18
percent among causes of death. In 1990 the most common types of cancer were breast
cancer, cancer of the stomach and liver, and skin cancer. In the last years of the Soviet
Union, about 680,000 new cases were diagnosed annually. The causes of cancer are varied
and complex, but contributing factors in Russia are heavy smoking, radiation exposure, and

countrystudies.us/russia/53.htm 1/8

Several autonomous republics. The declining number of births is attributed in part to a drop in fertility.Health contact with pervasive toxic emissions and chemicals in soil. The Soviet Union legalized abortion for medical reasons in 1955 and overall in 1968. Dagestan. and in part to women's reluctance to bear children in a time of economic uncertainty. The highest rates are found in the North Caucasus. But information about Western advances in birth control--and all modern means of birth control--was systematically kept from the public throughout the remaining Soviet decades. 3).2 per 1. and unmarried mothers receive maternity benefits. Petersburg and 8. For developed countries.2 in the Moscow region. According to the deputy minister of environmental protection and natural resources. Medical care for expectant mothers is among the least adequate aspects of the country's generally substandard system of health care.us/russia/53. for instance. Infant mortality rates vary considerably by region. poor health care. As a result of that policy. and Tyva. Infant Care. the annual birthrate for the first six months of 1992 was 11. especially in rural areas. Chechnya. today's Russian gynecologists lack the training to countrystudies. this share ranges between 4 and 17 percent. accidents. 9. eastern Siberia. which presumably stems from a combination of physiological and environmental factors. and Birth Control Some of the same factors shortening the lives of adults cause needless premature deaths of newborns in Russia. Unwanted pregnancies are common because of the limited availability and substandard quality of contraceptives and a reluctance to discuss sexual issues openly at home or to provide sex education at school. including Kalmykia. injuries. In the mid-1990s. and trauma. and environmental degradation have had an impact on the health of mothers and newborns." For example. Heavy-manufacturing regions show especially high rates. the rate was even lower. Poor overall health care and lack of medicines. In Russia an estimated 40 to 50 percent of infant deaths are caused by respiratory failure. reduce infants' survival chances. Central and northern European Russia's rates have been more in line with West European rates. A high percentage of pregnant women suffer from anemia and poor diets-- factors that have a negative effect on their babies' birth weight and general health. and water. In some areas. infectious and parasitic diseases. Maternity. the incidence of lung cancer among males is the highest in the world (see Environmental Conditions.000 population--a 12 percent decline from the same period in the previous year. No social stigma is attached to children born out of wedlock. western Siberia. ch. about 50 percent of all cancer-related illnesses can be attributed to environmental factors.5/18/12 Russia . social and economic underdevelopment. amounting to what one commentator calls "the quiet suicide of a nation. Russia's Ministry of Health reported in June 1991 that the country had a negative rate of population change for the first time since records have been kept. consistently record the highest rates in the Russian Federation. in Noril'sk. Russia's birthrate has shown an increasingly steep decline in the 1990s. modern forms of contraception are unavailable or unknown to most Russian women. In these areas. food.2 in St. In the intermediate category are the Urals. and the Volga Basin. the metallurgical center located above the Arctic Circle. and the Far East.htm 2/8 . Ingushetia.

and Tobacco Russia's rate of alcohol consumption. Gorbachev (in office 1985-91). Infant and child health in Russia is significantly worse than in other industrialized countries. which have been virtually eradicated in other advanced industrial societies. where they often contract contagious diseases. further undermines infants' health in a country where diets generally are unbalanced.) A 1995 Russian study found that regular drunkenness affected between 25 and 60 percent of blue-collar workers and 21 percent of white-collar workers. diphtheria. Even when immunizations are available. by 1987 the production of samogon (home- brewed liquor) had become a large-scale industry that provided alcohol to Russians while depriving the state of tax revenue. According to one study. as well as to low job productivity. involving substantially greater maternal risk than those performed earlier. In 1995 some 225 abortions were performed for every 100 live births. The inability of more than half of all new mothers to breast-feed. Statistically. In the twentieth century. however. only one child in five is born healthy.us/russia/53. Alcohol.Health advise women on contraception. When restrictions were eased in 1988. typhoid fever. pertussis. consumption of eight liters per year is likely to cause major medical problems. is a major contributor to the country's health crisis. most contraceptives were paid for by voluntary funds and international charities. 14 percent of the women in Russia with sixteen or more years of school had undergone eight to ten abortions. Vaccines are scarce. current consumption is estimated at about fifteen liters. Abortion remains the most widely practiced form of birth control in Russia. Rated as Russia's third most critical health problem after cardiovascular diseases and cancer. alcoholism has reached epidemic proportions.5/18/12 Russia . The number of abortions is much higher among Russian women than among Muslims and other minority groups. Narcotics. Even in Moscow in the mid-1990s. (According to World Health Organization standards. According to one study. parents often refuse them for their children because they fear infection from dirty needles. According to official statistics. the more likely a Muslim woman is to seek an abortion. mainly because of poor diet. particularly among males. with the highest incidence found countrystudies. between 1987 and 1992 annual per capita consumption rose from about eleven liters of pure alcohol to fourteen liters in 1992. The conditions under which abortions are performed often are primitive. Although some authorities credited reduced alcohol consumption with a concurrent drop in Russia's mortality rate. and poliomyelitis. it is estimated that nearly three-quarters of abortions take place after the first trimester of pregnancy. the higher her social status and the extent of her Russification. during the regime of Mikhail S. an estimated 22 percent of women of childbearing age were using contraceptives. are widespread among Russia's children. In the early 1990s. Illnesses such as cholera. traditionally among the highest in the world and rising significantly in the 1990s. periodic government campaigns against alcohol consumption have resulted in thousands of deaths from the consumption of alcohol surrogates. Another problem is that most women of childbearing age are employed and thus must place their young children in day care centers. the percentage was much lower in rural areas. alcohol consumption exceeded the pre-1985 level. Moreover. and public knowledge of the subject remains incomplete or simply mistaken. The latest such campaign was undertaken from 1985 to 1988.htm 3/8 . up from a rate of 196 per 100 in 1991.

cigarette advertising in the print media was prohibited. However.000 since 1991. Nevertheless. Aids Acquired immune deficiency syndrome (AIDS) likely was brought to the Soviet Union by students from countries with high levels of incidence of the disease. Smoking. which are more expensive but have less tar and nicotine than Russian brands. drugs were viewed officially as a capitalist vice. for them. Russians sometimes imbibe various combinations of dangerous substances.000 people died of alcohol poisoning. In 1995 an estimated 2 million Russians used narcotics. and because it is available in most places day and night. According to experts. Narcotics use has spread to new elements of society in recent years.Health in rural areas. more than twenty times the total recorded ten years earlier in the entire Soviet Union. Legally produced drugs often are stolen and move into the black market (see The Crime Wave of the 1990s. further endangering consumers. Production of often-substandard alcohol has become a widespread criminal activity in the 1990s. When import restrictions ended in the early 1990s. A modest government antismoking campaign paralleling Gorbachev's anti-alcohol campaign in the late 1980s had little effect. Russian experts rate the new class of Russian businesspeople as the group with the highest percentage of drug users. and some who cannot afford heroin inject themselves with other substances that cause illness or death. The increasing incidence of drug abuse was belatedly acknowledged by the Russian government as a public health problem. In the Soviet era. Medical treatment and educational programs now include hot lines in major cities and walk- in clinics that provide advice and treatment on an anonymous basis. compounds Russia's health crisis. once dominated by students and intellectuals. Russia legalized drug use (but not possession or sale) in 1991. Many addicts overdose. and health authorities believed that the figure was rising.htm 4/8 . doctors often recommend the purchase of American cigarettes. an increase of about 36. birth defects. the American cigarette industry found a large new market in Russia. rather than urge patients to quit. Synthetic drugs now are manufactured in small laboratories by professional chemists. In January 1996. the Supreme Soviet of the Soviet Union passed the countrystudies. Some schoolteachers have begun class discussions of drug-related issues and have distributed antidrug literature to students. If vodka is unavailable or unaffordable. a widespread habit. now includes large numbers of housewives and workers. The Russian media often report poisonings that result from consumption of homemade alcohol substitutes. unemployed people are especially prone to drunkenness and alcohol poisoning. after the first case of AIDS was confirmed in Russia.5/18/12 Russia . but that attitude disappeared soon after the Soviet Union dissolved. 10). in 1996 an estimated 55 percent of Russians were regular smokers. including alcoholics seeking a new means of escape. In 1994 some 53. ch. In 1987.us/russia/53. laws against possession are not dissuasive. with the number of users increasing 50 percent every year in the mid-1990s. Russia's drug problem remains largely intractable. The drug scene. Because alcohol remains cheap relative to food and other items. especially among women and teenagers. and smoking in theaters and workplaces generally was restricted to designated locations. Alcohol consumption among pregnant women is partly responsible for Russia's rise in infant mortality. some are easily fabricated by amateurs as well. success often includes the ability to purchase the most expensive narcotic. Chain-smoking is endemic in Russia. and childhood disease and abnormalities.

government officials and the public have ignored the need for preventive measures among Russians. the official statistics are understated at least tenfold because Russians in the groups most at risk--prostitutes. Petersburg.Health strictest anti-AIDS law in the world. of whom seventy-three were children. In 1986 the Soviet Union had 23. including 278 children. Rostov-na-Donu. and because it fails to allocate scarce funds to root causes of AIDS transmittal such as infection from hospital procedures and reuse of hypodermic needles. homosexuals. and AIDS sufferers meet much intolerance in Russian society. stipulates that all visitors remaining more than three months must prove that they are not infected with the AIDS-causing human immunodeficiency virus (HIV). which has been criticized vehemently for its human rights implications and the cost of its administration. and drug users--have reason to fear that results will not remain confidential and so refuse AIDS testing. had been registered as having HIV. Russia had a huge network of neighborhood and work-site clinics and first-aid facilities to provide readily accessible primary care. Although the 1990 Law on Prevention of AIDS mandates confidentiality of medical records.6 million beds.htm 5/8 .500 hospitals with more than 3. which nominally guaranteed full health protection to all citizens without charge. Volgograd. Before 1992 several mass infections of children occurred in medical facilities. Such facilities included about 28. according to an official of the Imena AIDS support group. the last three of which have medical facilities where unsanitary procedures have resulted in mass transmission of the virus. That system had been installed under Joseph V. This system has been criticized heavily. Official diagnoses of HIV increased 50 percent from 1993 to 1994. together with emergency ambulance services and sanatoriums. and that to that point 160 Russians.5/18/12 Russia . had died of AIDS. however. St. The highest incidence of HIV is in Moscow. and the Republic of Kalmykia. A 1995 law. which is devoted to rehabilitation of HIV victims. The government has established a diagnostic and screening infrastructure for AIDS prevention and control at the central and subnational levels. Stalin (in office 1927-53) with an emphasis on preserving a healthy work force as a matter of national economic policy.000 women's consultation centers and pediatric clinics. The release of statistics on the incidence of AIDS and other sexually transmitted diseases has been extremely slow. together with large hospitals and polyclinics to diagnose and treat more complex illnesses and to perform surgery. The majority of reported HIV-positive individuals are drug users. The Health System The glasnost period of the late 1980s first revealed the decay of the Soviet system of socialized medicine. As in the Soviet period.us/russia/53. making the knowing transmittal of the infection a criminal offense punishable by up to eight years in jail. in practice jobs often are lost and social services denied after a positive diagnosis. countrystudies. the Ministry of Health reported that 1. Because the disease has been associated with foreigners. AIDS transmittal is increased by a chronic shortage of condoms (which Soviet medical officials euphemistically called "Article Number 2") and by the lack of disposable hypodermic syringes in hospitals and clinics. because it tests only populations with little chance of infection. In the 1980s. In late 1995. However.023 Russians. the public receives little information about precautions against AIDS or the identity of the high-risk categories in society. which results in the repeated use of unsterilized needles.

In addition. In 1992 Russia had 662. in rural areas. The outline of the Soviet system did not change appreciably in the first half of the 1990s. but quality declined in nearly every aspect except the facilities designated for the elite. Despite the nominally equitable nature of Soviet socialized medicine. and 131 hospital beds per 10. The most outdated and abuse-ridden aspect of Soviet health care was psychiatric treatment. hospitals. The result was a serious overcrowding problem in hospitals despite the large number of beds available. and every year a large part of the national health care budget went to construction of new facilities. Physicians devoted an estimated 50 percent of their time to filling out forms. and sanatoriums for top party and government officials and other elite groups such as writers. Therefore. countrystudies. and especially according to political status. Patients preferred hospital treatment because hospitals were better equipped than clinics and because crowded living conditions made recuperation at home difficult. the actual system was highly stratified according to location. the average doctor's salary was roughly comparable to that of the average industrial worker.000 beds (about 5 percent) since 1990. often caused people suffering from relatively minor ailments such as influenza to be hospitalized. The Ministry of Health maintained a completely separate.us/russia/53. musicians. Among the doctors. and senior doctors made about US$150 per month. only nine medical institutes were attached to universities. Many large enterprises operated clinics that provided workers health care without requiring them to leave the work site." commit them to psychiatric hospital-prisons. In the mid-1980s. which suffered a shortage of doctors.000 population. Medical training emphasized practical work over basic research and pure science. with far inferior care and facilities available in rural areas. Such clinics aimed at reducing the incidence of sick leave. In 1988 the special psychiatric hospitals to which political dissidents had been committed were transferred from the jurisdiction of the Ministry of Internal Affairs to that of the Ministry of Health. the Soviet Union was first in the world in the ratio of hospital beds to population. actors. That system never advanced from the methodology of the 1950s. and little practice of individual or group counseling. Behind this system was a huge.000 to several thousand. In 1986 the Soviet Union had about 1. and administer powerful psychotropic drugs. and in 1983 the Soviet Union withdrew from the World Psychiatric Association to avoid censure for its abuses of the profession. estimates of the number of political prisoners in such institutions ranged from 1. multilevel bureaucracy directed from Moscow in consultation with organs of the CPSU.5/18/12 Russia . however. In the late 1980s. In 1996 the average Moscow specialist made about US$75 per month. which averaged 3 percent of the workforce per day in the 1980s. a drop of 97. a drop of about 32. such individuals often were the only medical personnel available. which included Pavlovian conditioned-response treatment. The structure of the Soviet system. vastly superior system of clinics.Health In the 1980s. which specified the length of treatment for every disease. heavy reliance on drug therapy.700 doctors.2 million paramedical and nursing personnel.000 since 1990. Paramedics and nurses needed only two years of training and no scientific background.htm 6/8 . Soviet psychiatry was at the service of the government to declare dissenters "insane.2 million doctors and about 3. and artists. most citizens preferred to suffer rather than submit themselves to treatment. All aspects of health service had nationwide annual programs with complex statistical accounting and goals.

which formerly accepted barter transactions and payment in rubles but now demand hard currency (see Glossary). In 1995 Russia had one doctor for every 275 citizens (compared with one for every 450 in the United States). no funding was available for any of the law's programs in 1996. Wheelchairs and artificial limbs are in very short supply. the public health delivery system in Russia was in crisis. Meanwhile. Russia's hospitals and polyclinics are generally old (about 15 percent were built before countrystudies.us/russia/53. Even when pharmaceuticals are available in Russia.4 percent of the national budget to 1. contacts with Western experts. and are badly paid. 39. a scarce item in Russia. On the Social Protection of Disabled Persons in the Russian Federation.600 pediatricians. ultrasound units.300 psychiatrists. from prevention to emergency treatment. and equipment. and various other equipment for monitoring labor and delivery. they often are priced beyond the reach of doctors and patients.600 were surgeons.htm 7/8 . and wheelchair ramps are virtually nonexistent. current medical journals. and 18. a sharp decline in state funding has affected all aspects of medical care. who often extract bribes for both materials and services. In the early 1990s. Although Russia pioneered in some specialized fields of medicine such as laser eye surgery and heart surgery. Facilities for the disabled. The nonconvertibility of the ruble also has hindered Russia's ability to purchase medicines abroad. The combination of bribes and authorized charges puts many types of medical treatment beyond the reach of all but the wealthy. Soviet-era supplies of materials and drugs have been depleted and are not being adequately replenished. most such personnel are poorly trained. state funding declined from 3. Elderly people are hit especially hard by this situation. Although the number of doctors and paramedics has remained sufficiently high to ensure the provision of adequate treatment. employment. Many medical schools suffer from shortages of instructors. A 1995 law. rehabilitation centers are few. Low salaries have made corruption common among medical personnel. Russia relies increasingly on imports from former Soviet-bloc nations in Central Europe. also fall far below Western standards. although health care is free in principle. Between 1990 and 1994.5/18/12 Russia . The shortage of medicines in Russia is chronic and catastrophic. needless deaths from heart disease occur because hospitals lack the equipment needed to perform bypass surgery and angioplasty. 77. and pharmaceuticals. including equal access to education. transportation. For example.8 percent.600 gynecologists. Many of the items produced are ineffective. but the quality of training varied considerably. technology. the chances of receiving adequate treatment may depend on the patient's wealth. The law requires businesses to set aside at least 3 percent of their jobs for the disabled. the country's medical establishment is generally deficient in hospital equipment. In 1993 about forty institutions offered medical training. Thus. for their products. 20. Domestic production has plummeted because of the obsolescence of pharmaceutical factories and shortages of requisite raw materials and supplies. of whom about 6 million reside in Russia. provides for a wide range of benefits and services.500 neurologists. but about half of medical school graduates cannot diagnose simple ailments or read an electrocardiogram when they enter practice. However. preventable infant deaths result from an absence of fetal heart monitors. textbooks. lack modern equipment.Health 78. and services.

the state discouraged alternative medicine by arresting practitioners. Vegetables often are scarce in Russia. By the mid-1990s. and they lack basic amenities. About 18 percent of hospitals and 15 percent of clinics are not connected to a sewerage system. Even in the best hospitals. Aside from shortfalls in Russia's health facilities and the quality of medical personnel. and fruits never have constituted an important element of the Russian diet. much of the country's public health crisis stems from poor personal hygiene and diet and lack of exercise. In the Soviet era. according to a Yeltsin adviser on social policy. compared with 6 percent in Britain and more than 12 percent in the United States. However. was the creation by 2000 of a "unified system of health care" for the entire population. as are programs to educate the public about personal sanitation.000. In 1995 less than 1 percent of Russia's budget was earmarked for public health. Per capita meat consumption also has fallen in the 1990s (see table 6. has encouraged many Russians to turn to unorthodox alternatives such as faith healing. except in rural areas where they are homegrown.5/18/12 Russia . not to mention the air. They offer personalized attention and affordable cures such as birch bark and cranberries to cure a variety of complaints. Library of Congress countrystudies. Roughly 42 percent of the country's hospitals and 30 percent of its clinics lack hot water. proper diet.Health 1940). Russians with access to a plot of land often grow their own herbs. The proclaimed goal. and only 12 percent in both categories have central heating. herbal medicine. and mysticism.us/russia/53. President Yeltsin signed a decree entitled On Immediate Measures to Provide Health Care for the People of the Russian Federation. water. surgical instruments are not always properly sterilized. Long-practiced cures such as wrapping oneself in a vinegar-soaked blanket and drinking one's own urine have become more widespread in the 1990s. and as many as 80 percent of Russians needing medical assistance have turned to them. the number of such individuals was estimated at 300. have no running water at all. Experts forecast that such a meager outlay will not address the major shortfalls in Russia's health care system.htm 8/8 . economic constraints are likely to stymie achievement of that goal in the near future. Russia's government is attempting to equalize the distribution of health care by fragmenting the Soviet-era network of top-level medical facilities for exclusive use of the elite. By 1995. and vitamins. Traditional folk healers constitute the largest group of nontraditional practitioners. with patients often standing in line at clinics for an entire day before receiving brief diagnoses and prescriptions for drugs they cannot afford. and 12 percent and 7 percent. Search Custom Search Source: U. Preventive medicine and wellness programs are virtually nonexistent. and books describing home cures have become popular. The impersonality and inaccessibility of national health system facilities. In the spring of 1993. which already had been established in the 1980s. respectively. however. Appendix).S. and rates of infection are abnormally high. and soil pollution that continue to contribute insidiously to worsening public health. private medical clinics were serving a growing number of Russians able to afford their care. The average Russian does not consume a balanced diet. medical personnel do not regularly wash their hands.

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